At a time when more health care organizations are launching hospital-at-home programs, operators in this space need to educate their clinicians to expect data variations. This is one of the key takeaways from a recent whitepaper released by Best Buy Health.

The whitepaper distills Best Buy Health’s years of experience implementing remote patient monitoring (RPM) through hospital-at-home into several key lessons. The company is a subsidiary of the electronics giant Best Buy (NYSE: BBY).

Since 2017, Best Buy Health has implemented more than 40 acute care home monitoring programs across the U.S. and U.K. Additionally, Best Buy Health has monitored over 34,000 patients.

Prior to rolling out a hospital-at-home program it’s important to train clinicians, in order to help them get comfortable with a new data source.

“Repeat training sessions with clinicians as they gain familiarity with this new stream of data,” Best Buy Health wrote. “Patients and caregivers should also be trained to use the technology, and if the collected vital signs are visible to patients and carers, prepare them for what they might see to avoid any undue concern.”

Best Buy Health also noted that gaps in continuous data from the home isn’t out of the norm.

Another lesson Best Buy Health emphasizes is the choosing technology based on the goals of the program, instead of just adopting whatever is available. This also means considering things like interoperability, cybersecurity, and the flow of aggregated data into the EHR.

Monitoring how well the technology works in relation to the target population is also important.

“Regulatory clearance is the minimum bar for any clinical device, but laboratory validation studies give little indication of how well the technology will perform in the home,” the organization wrote. “Testing technology in the context of the home is helpful to ensure it provides data of sufficient quantity and quality for the needs of the program. Patient adherence is a key component, so testing should include evaluations of usability and satisfaction.”

When operating in the home it’s helpful to individualize alarms, according to Best Buy Health.

“We advise using alarm thresholds tailored to individual patients and based on their clinical condition, risk and social circumstances, rather than generic hospital ‘normal’ values,” the organization wrote. “Their baseline values should be established early on, and then the focus should be on deviations from that baseline, rather than absolute values.”

Even with individualized alarms, clinicians shouldn’t solely rely on this. Best Buy Health recommends conducting rounds on a virtual care patient’s data.

“Our monitoring team conducts a ‘round’ on patients every 4-6 hours, as they might on the hospital floor,” the organization wrote. “A ‘round’ involves reviewing the patient’s vital signs and any asynchronous communications. This helps nurses establish patterns that differentiate the routine from the pathological, as well as detecting issues like incorrect device wear. Nurses also use proxy indicators to assess patients.”

Ultimately, clinicians setting appropriate standards of care is paramount.

“Monitor clinicians as they develop meaningful relationships with their patients,” Best Buy Health wrote. “With time, they will gain confidence to not disturb patients with every change in vital signs — even in the acute setting. While this approach is beneficial, it also poses a medicolegal risk, as the clinicians may choose not to respond to values traditionally considered ‘abnormal’ in the hospital, to allow patients space to recover.”